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de conventioneel versus digitaal vervaardigde splint

(2016)Keur, R. (Rogier)

Aim: The occlusal splint is an appliance used to influence the signs and symptoms of
temporomandibular dysfunction (TMD) and to protect the teeth from excessive wear due to
bruxism. There is no consensus in the literature about the therapeutic effect of occlusal splints,
however there is agreement on the behaviour changing effect. The explanation for this is that
because of the patients’ anticipation on the outcome of the intervention buxism decreases. This
underlines the importance of a well-fitting splint. The occlusal appliance can be manufactured
in a conventional way as by digital designing and thereafter milling the splint out of acrylic
resin. The aim of this study is to find out which method leads to a better result.
Materials and method: This study is a doubleblind randomised pilot study. The study
population was, after exclusion, a group of 34 dental students aged 20-35 years old. With these
students, alginate impressions of the upper and lower arch were made, as well as a wax bite in
maximal occlusion decreasing the vertical overbite with a minimum of 2,5 mm. One half of the
group received a conventionally manufactured splint without button anchors and the other half
received a digitally designed and milled splint. Both types of splint were of the Michigan type
with canine guidance. Research was done on the stone models, during the phase in which the
splints were placed and during a digital bite registration. The variables that have been measured
are occlusion, articulation, fit, retention and wear comfort. The programs R and IBM SPSS
were used to compare these variables in the study groups for statistical significance. In this
study a 95% confidence interval was chosen.
Results: A statistically significant difference between the two types of splint was found
in the variables fit ((U=84,000; p=0,036) and retention (p=0,001), both measured on the stone
models. In addition to that, a statistically significant difference was found in the retention
judged by the study population (p=0,01346) and the number of occlusal contact points in the
anterior region measured by the T-scan (U=78,000; p=0,020). All these mentioned differences
were in favor of the digitally designed splints. The variable occlusion in this study is subdivided
in ‘symmetrical contact between the left and the right side of the splint’, ‘the number of occlusal
contact points left and right on the splint’ and ‘simultaneous and evenly contact when coming
in occlusion’. The first two mentioned variables were measured with both articulating paper
and the T-scan and the last one mentioned was judged by the study population. Despite the fact
that no significant difference was found in the first two mentioned variables, the digitally
designed splints scored better on average than the conventionally manufactured splints which
shows a trend. This was also the case for the ‘wear comfort’ although both types of splint scored
low. This trend was not seen in the variables ‘articulation’ and ‘distribution of the bite force
measured by the T-scan’ and ‘simultaneous and evenly contact when coming in occlusion’.
Discussion and conclusion: The digitally designed and manufactured occlusal splint
scored, in most of the researched variables, better on average than the conventionally
manufactured splint. In a couple of cases this difference was also found to be statistically
significant. One can consequently say that there is a tendency in favour of the digitally
designing and manufacturing way of producing an occlusal splint.